Every dentist has experienced it. You diagnose a patient who clearly needs a crown, an implant, or restorative work. You explain the treatment plan. The patient nods. And then they walk out the door — and you never see them again for that procedure.
This isn't a once-in-a-while problem. According to data from Dental Intelligence, treatment acceptance by dollar amount averages just 35–45% across general dentistry practices. The Levin Group estimates that two-thirds of U.S. dental practices fall between 20% and 50% acceptance — well below the industry target of 90%.
The American Dental Association puts a stark number on it: the average dental practice has $500,000 to $1,000,000 in unscheduled treatment plans sitting in their system at any given time.
And the trend is moving in the wrong direction. An Inside Dentistry survey found that only 46% of respondents reported having the majority of complex treatment plans accepted in 2025 — down from 54% the year before.
Where cases actually fall apart
The instinct is to blame patients. They're scared, they can't afford it, they don't prioritize dental health. And while patient-side factors are real, the data tells a different story about where the biggest losses happen.
A 2024 McKinsey healthcare report found that 50–60% of revenue leakage in provider organizations is operational — not clinical. Delayed follow-up, inconsistent communication, poor handoffs, and slow patient progression are the primary culprits.
In a dental practice, the treatment conversion funnel has several stages where cases silently disappear:
Stage 1: Treatment planned but insurance not submitted
The dentist recommends treatment, but the pre-determination (Pre-D) is never sent to insurance. This happens more often than anyone wants to admit — especially in busy practices where the front desk is juggling phone calls, check-ins, and billing simultaneously. Without a system flagging "this patient needs a Pre-D submitted," the case simply sits.
Stage 2: Pre-D sent but response not tracked
The Pre-D goes to insurance. Insurance responds — sometimes in 3 days electronically, sometimes in 2–3 weeks by mail. But if nobody is actively monitoring which Pre-Ds have come back and which are still outstanding, approved treatments pile up without anyone contacting the patient. In multi-location practices, this problem multiplies because there's no centralized view.
Stage 3: Insurance approves but patient is never contacted
This is the most painful drop-off point. Insurance has said "yes." The treatment is covered. But the patient doesn't know that, because nobody called them. Research shows that approximately 40% of patients who don't receive follow-up scheduling after a dental visit never return for the recommended treatment.
Stage 4: Patient contacted but never scheduled
Staff reaches the patient, explains the coverage, but doesn't convert the conversation into a booked appointment. Without tracking who was contacted, what was said, and when to follow up again, these patients drift away.
Stage 5: Scheduled but doesn't show up
No-shows are the final leak. Industry data shows practices lose an average of $105,000+ annually from missed appointments alone, with no-show rates ranging from 4% to as high as 30%.
The conversion problem isn't one big failure — it's five small ones compounding across every patient. Each stage leaks 10–30% of cases, and by the end of the funnel, only 35% of recommended treatments survive to completion.
Why this keeps happening
Most dental practice management software — including Dentrix, the most widely used system with 35,000+ installations — is excellent at recording what happened. A procedure was planned. A claim was submitted. An appointment was booked.
What these systems don't do well is tell you what should happen next. They don't flag that a Pre-D was sent 10 days ago with no response. They don't alert the team that insurance approved a $4,000 crown last week but the patient hasn't been called. They don't show a practice manager which stage is losing the most cases across multiple clinics.
The result is that practices rely on manual tracking — spreadsheets, sticky notes, memory — to bridge the gap between "treatment recommended" and "treatment completed." This works when volume is low. It breaks down fast when you're managing hundreds of cases across multiple providers and locations.
What the math actually looks like
Let's make this concrete for a single clinic producing $100,000/month in recommended treatments:
- At 35% conversion: $35,000 completed = $65,000 lost per month
- At 50% conversion: $50,000 completed = $50,000 lost per month
- Difference: $15,000/month = $180,000/year recovered per clinic
For a multi-location group with 5–6 clinics, the gap between 35% and 50% conversion represents over $1 million per year in recoverable revenue. This isn't theoretical new production — it's treatments that were already diagnosed, already recommended, and in many cases already approved by insurance.
How to fix the conversion funnel
The practices achieving 60–75% acceptance rates (which Practice by Numbers reports as the top-performer range for comprehensive care) aren't doing anything exotic. They're doing the basics — consistently, systematically, and with visibility.
1. Track every case through every stage
You can't improve what you can't see. The first step is having a system that shows you exactly where every recommended treatment sits in the pipeline: submitted to insurance, waiting for response, approved and awaiting patient contact, contacted but not yet scheduled, scheduled, or completed. When a practice manager can see "we have 47 approved cases where nobody has called the patient," that's an actionable problem — not an invisible one.
2. Automate the reminders
Staff shouldn't have to remember to check on Pre-D responses. When a Pre-D is sent, a 3-day follow-up reminder should fire automatically. When insurance responds, a "contact patient within 24 hours" task should appear. When a case sits in "contacted" status for more than a week without being scheduled, an escalation should trigger. The system should do the remembering so staff can do the work.
3. Measure weekly, not quarterly
Monthly or quarterly reviews catch problems too late. Weekly cohort tracking — how many cases entered the funnel this week, how many moved to the next stage, where did cases stall — gives practice managers the real-time visibility to course-correct before revenue is permanently lost.
4. Compare across clinics and providers
In multi-location practices, one clinic may be converting at 45% while another sits at 25%. Without comparison data, the underperforming location has no benchmark and no pressure to improve. Similarly, doctor-level conversion data reveals which providers need coaching on treatment presentation versus which need better follow-up support from staff.
See where your cases are falling through
DentaHub tracks every treatment from Pre-Determination through completion — automatically synced from Dentrix across all your clinics.
Book a Free Demo →The bottom line
The 35% treatment completion rate isn't a clinical problem — it's a workflow problem. Patients aren't refusing care because the dentistry is bad. They're falling out of a conversion funnel that has no guardrails, no automated follow-up, and no centralized visibility.
The practices that solve this problem don't need more patients. They need to stop losing the ones they already have.